Family Practitioners’ Methods of Diagnosis
DOI: 10.3238/zfa.2017.0493–0498german translation / full article
Summary: Family practitioners (FPs) often find it difficult to explain their diagnostic reasoning. Still, it has to be described adequately to students as well as to the public. We present the results of recently published studies exploring diagnostic thinking and behavior of German FPs. “Inductive foraging” and “triggered routines” emerged from this line of research as novel concepts. They describe an efficient exploration of the almost infinite range of problems that is typical for family medicine. To this exploration, the patient makes an essential contribution. These findings put the so-called hypothetico-deductive reasoning into perspective, which up to date has been the most popular theory of medical reasoning. Another intriguing finding is the assumption entertained by FPs that each patient has an individual threshold for seeking medical help. From this assumption, which is based on previous practice visits, FPs derive their opinion on whether the patient does or does not have a specific serious disease. Further diagnostic actions are adjusted accordingly. We thus propose a mechanism to describe how continuity of care and knowledge of the patient impact the diagnostic process. These findings are presented and their relevance for teaching and practice is discussed.